title: Attentional focus of feedback for improving performance of reach-to-grasp after stroke: a randomised crossover study.
abstract: OBJECTIVE
  To investigate whether feedback inducing an external focus (EF) of attention (about movement effects) was more effective for retraining reach-to-grasp after stroke compared with feedback inducing an internal focus (IF) of attention (about body movement). It was predicted that inducing an EF of attention would be more beneficial to motor performance.
  
  
  METHODS
  Crossover trial where participants were assigned at random to two feedback order groups: IF followed by EF or EF followed by IF.
  
  
  METHODS
  Research laboratory.
  
  
  METHODS
  Forty-two people with upper limb impairment after stroke.
  
  
  METHODS
  Participants performed three reaching tasks: (A) reaching to grasp a jar; (B) placing a jar forwards on to a table; and (C) placing a jar on to a shelf. Ninety-six reaches were performed in total over one training session.
  
  
  METHODS
  Kinematic measures were collected using motion analysis. Primary outcome measures were movement duration, peak velocity of the wrist, size of peak aperture and peak elbow extension.
  
  
  RESULTS
  Feedback inducing an EF of attention produced shorter movement durations {first feedback order group: IF mean 2.53 seconds [standard deviation (SD) 1.85]; EF mean 2.12 seconds (SD 1.63), mean difference 0.41 seconds; 95% confidence interval -0.68 to 1.5; P=0.008}, an increased percentage time to peak deceleration (P=0.01) when performing Task B, and an increased percentage time to peak velocity (P=0.039) when performing Task A compared with feedback inducing an IF of attention. However, an order effect was present whereby performance was improved if an EF of attention was preceded by an IF of attention.
  
  
  CONCLUSIONS
  Feedback inducing an EF of attention may be of some benefit for improving motor performance of reaching in people with stroke in the short term; however, these results should be interpreted with caution. Further research using a randomised design is recommended to enable effects on motor learning to be assessed.
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
authors.forename: K F
authors.initials: KF
authors.lastname: Durham
authors.affiliation: Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham, UK; Faculty of Medicine and Health, University of East Anglia, Queens Building, Earlham Road, Norwich, Norfolk, NR4 7TJUK.
authors.forename: C M
authors.initials: CM
authors.lastname: Sackley
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
authors.forename: C C
authors.initials: CC
authors.lastname: Wright
authors.affiliation: School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Wing
authors.affiliation: School of Sport Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
authors.forename: M G
authors.initials: MG
authors.lastname: Edwards
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK; School of Health Sciences, University of Newcastle, Hunter Building, University Drive, Callaghan, NSW, 2308, Australia. Electronic address: paulette.vanvliet@newcastle.edu.au.
authors.forename: P
authors.initials: P
authors.lastname: van Vliet
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D018592:Cross-Over Studies; D005246:Feedback; D005260:Female; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D000071939:Stroke Rehabilitation; D034941:Upper Extremity / Q000502:physiology
keywords: Feedback; Rehabilitation; Stroke; Upper extremity